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September 30, 2025Open Access

Transitioning to da Vinci Xi for colorectal cancer surgery: a prospective cohort study of 102 cases from a UK centre with a structured robotic programme

SMSamuel MassiasWest Hertfordshire Hospitals NHS Trust BVBhamini VadhwanaWest Hertfordshire Hospitals NHS Trust ARArian Arjomandi RadCardiac Surgery

Key Points

The introduction of the da Vinci Xi robotic platform significantly improved oncological outcomes and reduced hospital stays.
During the study, the anastomotic leak rate was low at 1%, with conversion to open surgery recorded at only 3%.
Learning curves indicated that surgeons with prior robotic experience achieved faster proficiency when using the da Vinci Xi system.
CUSUM analysis showed stabilization of skills after about 12 specific procedures, indicating effective training methodologies.

Abstract

Abstract This study evaluated short-term outcomes and learning curves following the introduction of the Intuitive© da Vinci Xi robotic platform for elective colorectal cancer resections at West Hertfordshire Teaching Hospital NHS Trust (WHTH). A smooth transition was enabled by prior experience with the CMR Surgical© Versius platform, with outcomes benchmarked against national data. A prospective cohort study included consecutive patients undergoing elective colorectal resections between April 2024 and March 2025. Data included demographics, diagnosis, operative details, complications, length of stay (LOS), and oncological outcomes. Results were compared with historical laparoscopic data from the National Bowel Cancer Audit (NBOCA, 2019–2022) and Model Health System (MHS, 2024). Learning curves for operative time were assessed using cumulative sum (CUSUM) analysis across three procedures: right hemicolectomy (RH), anterior resection (AR), and abdominoperineal resection (APR). A total of 102 patients were included, with a median age of 69 years (IQR = 60–75), and 54.9% ( n = 56) were male. All colonic resections ( n = 72) achieved a lymph node yield ≥ 12, significantly higher than the 88.1% in NBOCA ( p = 0.001). Among rectal resections ( n = 30), 96.7% had negative margins versus 90.1% in NBOCA ( p = 0.10). Conversion to open surgery was 3% ( n = 3), the anastomotic leak rate was 1% ( n = 1), and 4% ( n = 4) required a return to theatre. MHS data showed that 13% of all colorectal patients at WHTH had a LOS ≥ 9 days, compared to 29% nationally ( p = 0.0001), decreasing to 7.1% in the robotic cohort. CUSUM analysis showed stabilisation after ~ 12 right hemicolectomies and 20 low pelvic resections, with variability among surgeons. Surgeons with prior robotic experience achieved faster proficiency and generated time savings. The successful introduction of the da Vinci Xi platform at WHTH, supported by prior Versius experience, led to excellent oncological outcomes, shorter hospital stays, and low complication rates. These findings highlight the value of structured robotic implementation in advancing colorectal cancer care within the NHS.

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